RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2014-01344 COUNSEL: NONE HEARING DESIRED: YES APPLICANT REQUESTS THAT: His Servicemembers’ Group Life Insurance Traumatic Injury Protection (TSGLI) appeal application be approved and he be paid an additional $25,000. APPLICANT CONTENDS THAT: His doctor clearly annotated in his TSGLI application that he was unable to perform the Activities of Daily Living (ADL) for 60 days. He was unable to use his arm and required assistance for 60 days. The military did not clear him for duty until 15 Sep 03. He submitted this same package in Aug 13. His medical provider documented that he was unable to perform 4 of the 6 ADLS for 60 days. The applicant’s complete submission, with attachments, is at Exhibit A. STATEMENT OF FACTS: The applicant is a member of the Air Force Reserve. According to his DD Form 214, Certificate of Release or Discharge from Active Duty, he served on this period of active duty from 1 Oct 02 to 11 Aug 05. According to a medical report dated 10 Jul 03, the applicant cut his right arm on 9 Jul 03 with a piece of glass from a broken tabletop. He had 2 lacerations to his forearm and one over the radial aspect of the wrist. Both wounds were sutured. According to the Hand Surgery Center, Operative Report dated 14 Jul 03, he received surgery to repair the lacerations to his tendons, nerve and radialis in his right arm. According to a SF 600, Chronological Record of Medical Care, dated 11 Jul 03, the applicant presented to flight medicine to report he injured himself in an accident on 9 Jul 03. He was carrying a glass table out of his house when he fell and received acute lacerations to his right forearm and wrist. He was seen in the emergency room at University Hospital, Cincinnati, OH where his lacerations were closed. He was scheduled to be evaluated on 14 Jul 13 for re-exploration of his wound. He was coded as Duty Not Involving Flying (DNIF). Per AF Form 422, Physical Profile Serial Report, dated 24 Jul 03, the applicant was restricted from any duties involving the use of his right arm and was documented as not Worldwide Qualified (WWQ). The release date of the duty restriction was 1 Sep 03. According to the Hand Surgery Specialists note dated 24 Aug 03, he was cleared to return to work or school without restriction. Per AF Form 422, dated 15 Sep 03, he was returned to duty with no restrictions and was documented as WWQ. Payment for loss of ADL due to traumatic injury other than brain injury is paid as follows: $25,000 at the 30th consecutive day, an additional $25,000 at the 90th consecutive day, and an additional $25,000 at the 120th consecutive day. AIR FORCE EVALUATION: AFPC/DPFC recommends denial. On 5 May 05, Public Law 109-13 established a traumatic injury program designed to provide financial assistance to service members during recovery from a serious traumatic injury (not necessarily as a result of combat). TSGLI is a rider to the SGLI policy. TSGLI pays a monetary benefit from $25,000 to $100,000 for covered losses that are incurred by the member as a result of traumatic injury. Code of Federal Regulations (CFR) Title 38 Para 9.20 prescribes that each service certifies whether a service member was insured under SGLI and whether they sustained a qualifying loss. The TSGLI loss criteria are prescribed in the TSGLI Procedures Guide. A member is considered to have a loss of ADL if the member requires assistance to perform at least 2 of 6 ADL (eating, bathing, dressing, toileting, transferring and continence). Based on the eligibility criteria outlined in CFR Title 38 9.20 and the recommendation of the physician’s review of the original claim and appeal, the applicant’s TSGLI claim does not meet the TSGLI eligibility criteria for payment of ADL loss for 60 consecutive days. On 17 Mar 13, the applicant submitted a TSGLI application claiming the inability to perform the ADL of bathing, dressing, eating and toileting beginning 10 Jul 03 (signed by the certifying medical professional on 21 Feb 13). The claim and medical records were reviewed and his request for loss of ADLs (bathe, dress, toilet) due to Other Traumatic Injury (OTI) from 10 Jul to 21 Aug 03 was approved and he was paid $25,000 on 5 Jun 13. On 5 Sep 13, the applicant submitted an appeal for ADL loss through the 60 day threshold. The medical review included the following statement, “he was paid for 30 days ADL loss with the original claim. There is no indication whatsoever that the applicant could not perform all ADL using his non-dominant hand and arm. While performing these ADLs would not have been as efficient with the non-dominant arm and hand, he was not rendered unable to perform them.” On 31 Jan 14, the appeal authority signed the denial of his appeal. The burden of proof is on the applicant to provide evidence that his ADL loss reached the 60 day threshold. To the contrary, the evidence provided indicates the applicant’s medical provider released the patient to return to work without restrictions on 24 Aug 03 (reference Hand Surgery Specialists, Incorporated, note dated 24 Aug 03). It is reasonable to infer that the applicant was able to perform the cited ADLs at that time. A complete copy of the DPFC evaluation is at Exhibit C. APPLICANT'S REVIEW OF AIR FORCE EVALUATION: A copy the Air Force evaluation was forwarded to the applicant on 27 Jun 14 for review and comment within 30 days (Exhibit D). As of this date, no response has been received by this office. THE BOARD CONCLUDES THAT: 1. The applicant has exhausted all remedies provided by existing law or regulations. 2. The application was timely filed. 3. Insufficient relevant evidence has been presented to demonstrate the existence of error or injustice. We took notice of the applicant's complete submission in judging the merits of the case; however, we agree with the opinion and recommendation of the Air Force office of primary responsibility and adopt its rationale as the basis for our conclusion that the applicant has failed to sustain his burden of proof that he has been the victim of an error or injustice. Therefore, in the absence of evidence to the contrary, we find no basis to recommend granting the relief sought in this application. 4. The applicant’s case is adequately documented and it has not been shown that a personal appearance with or without counsel will materially add to our understanding of the issues involved. Therefore, the request for a hearing is not favorably considered. THE BOARD DETERMINES THAT: The applicant be notified the evidence presented did not demonstrate the existence of material error or injustice; the application was denied without a personal appearance; and the application will only be reconsidered upon the submission of newly discovered relevant evidence not considered with this application. The following members of the Board considered AFBCMR Docket Number BC-2014-01344 in Executive Session on 26 Feb 15 under the provisions of AFI 36-2603: , Panel Chair , Member , Member The following documentary evidence was considered: Exhibit A. DD Form 149, dated 1 Mar 14, w/atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Memorandum, AFPC/DPFC, dated 5 Jun 14. Exhibit D. Letter, SAF/MRBR, dated 27 Jun 14.